远端胃癌根治术后三种消化道重建方式的比较研究

目的比较远端胃癌根治术后3种不同消化道重建方式的治疗效果。方法回顾性分析2007-2010年问在贵阳医学院附属医院接受远端胃大部分切除术的169例胃癌患者的临床资料．按不同消化道重建方式分为BilkothⅠ式组（60例）、BillrothⅡ式组（41例）和胃空肠Roux-en-Y吻合组（68例）。比较3组患者术中及术后恢复情况;并通过特殊症状量表评估3组患者术后3个月的生活质量。结果与Billroth Ⅰ式组和Billroth Ⅱ式组相比,胃空肠Roux-en-Y吻合组患者手术时间更长[（266．3±70．4）min比（196．2±54.3）min和（228．5±67．7）min],术中出血量更多[（220．9±67．6）ml比（170．5±61．5）ml和（188．5±76．7）ml],但其术后拔除胃管时间更短[（2．6±1．5）d比（3．1±1-3）d和（3．6±1．2）d],术后反流和烧心症状更为轻微（特殊症状量表评分1．8±0．4比1．9±0．6和2．6±0．4）：差异均有统计学意义（均P〈0．05）。结论Roux-en-Y吻合术虽不符合生理通道,操作也较为复杂．但其能有效地防止反流性食管炎的发生,是较为理想的远端胃癌根治术后消化道重建术式。

Comparison among three reconstruction techniques after distal radical gastrectomy

Objective To compare surgical efficacy after three different reconstruction techniques after radical resection of distal gastric cancer. Methods Clinical data of 169 cases of distal gastric cancer operated in our hospital from 2007 to 2010 were retrospectively analyzed. The reconstruction techniques included Billroth Ⅰ anastomosis （n=60）, Billroth Ⅱ anastomosis （n =41 ）, and Roux-en-Y anastomosis （n= 68）. Efficacy among 3 groups was compared. Specific symptoms scale was used to evaluate the quality of life in three methods after three months. Results Compared to Billroth Ⅰ anastomosis and Billroth Ⅱ anastomosis, Roux-en-Y anastomosis had longer operative time[ （266.3±70.4） rain vs. （196.2±54.3） min, and （228.5±67.7） mini, more blood loss[ （220.9±67.6） ml vs. （170.5±61.5） ml and （188.5±76.7） ml], and shorter time to gastric tube removal [（2.6±1.5） d vs. （3.1±1.3） d and （3.6±1.2） d], milder postoperative reflux and heartburn sensation （specific symptoms scale, 1.8±0.4 vs. 1.9±0.6 and 2.6±0.4, P〈0.05）. Conclusions Although Roux-en-Y anastomosis is not consistent with physiological route and the procedure is more complex to perform, it can effectively prevent reflux complications. Roux-en-Y anastomosis is a better reconstruction technique after radical resection of distal gastric cancer.